title: Third-generation autofluorescence endoscopy for the detection of early neoplasia in Barrett's esophagus: a pilot study.
abstract: In Barrett's esophagus (BE), second-generation autofluorescence imaging (AFI-II) improves targeted detection of high-grade intra-epithelial neoplasia (HGIN) and early cancer (EC), yet suffers from high false-positive (FP) rates. The newest generation AFI (AFI-III) specifically targets fluorescence in malignant cells and may therefore improve detection of early neoplasia and reduce FP rate. The aim was to compare AFI-III with AFI-II for endoscopic detection of early neoplasia in BE. BE patients with endoscopically inconspicuous neoplasia underwent two diagnostic endoscopies (AFI-II/AFI-III) in a single session. End-points: number of patients and lesions with HGIN/EC detected with AFI-II and AFI-III after white-light endoscopy (WLE) and the value of reinspection of AFI-positive areas with WLE and narrow-band imaging. Forty-five patients were included (38 males, age 65 years). Nineteen patients showed HGIN/EC. AFI-II inspection after WLE increased detection of HGIN/EC from 9 to 15 patients (47 to 79%); AFI-III increased detection from 9 to 17 patients (47 to 89%). WLE plus random biopsies diagnosed 13/19 (68%) HGIN/EC patients. One hundred and four abnormal AFI areas were inspected; 23 (22%) showed HGIN/EC. AFI-II increased detection of HGIN/EC from 10 to 18 lesions (43 to 78%). AFI-III increased detection from 10 to 20 lesions (43-87%). FP rate was 86% for AFI-II and AFI-III. Reinspection with WLE or narrow-band imaging reduced FP rate to 21% and 22%, respectively, but misclassified HGIN/EC lesions as unsuspicious in 54% and 31%, respectively. This first feasibility study on third-generation AFI again showed improved targeted detection of HGIN/EC in BE. However, the results do not suggest AFI-III performs significantly better than conventional AFI-II.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: D F
authors.initials: DF
authors.lastname: Boerwinkel
authors.forename: J A
authors.initials: JA
authors.lastname: Holz
authors.forename: M C G
authors.initials: MC
authors.lastname: Aalders
authors.forename: M
authors.initials: M
authors.lastname: Visser
authors.forename: S L
authors.initials: SL
authors.lastname: Meijer
authors.forename: M I
authors.initials: MI
authors.lastname: Van Berge Henegouwen
authors.forename: B L A M
authors.initials: BL
authors.lastname: Weusten
authors.forename: J J G H M
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D062048:Narrow Band Imaging; D061848:Optical Imaging; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000473:pathology*
keywords: Barrett's esophagus; autofluorescence imaging; endoscopy; narrow-band imaging; neoplasia